Path - Stomach Flashcards by Ahmed Radwan

early and late sx of gastric adenocarcinoma

early: dyspepsia, dysphagia, and nausea
late: weight loss, anorexia, early satiety, anemia, hemorrhage

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KIT tyrosine kinase and PDGFRA gain of function mutation

gastrointestinal stromal tumor (GIST)

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irregular enlargement of the gastric rugae in the body and fundus, glands elongated with corskcrew like appearance w/ cystic dilation

menetrier dz

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t(11:18)(q21:21) translocation

MALToma

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H. pylori inducing inflammation which triggers NF-KB activation through MLT-BCL-10, leading to ______

MALToma

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symptoms of jejunum and ileum carcinoid tumors

asymptomatic, obstruction, metastatic dz

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compare acid production of H. pylori gastritis and autoimmune gastritis

H. pylori: increased or normal

autoimmune: decreased

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diffuse atrophy, thinned mucosa in body and fundus, loss of rugal folds

autoimmune gastritis

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mucosal inflammation with scant inflammatory cells

gastropathy

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rare, improperly branched submucosal artery within the wall of the stomach that causes gastric bleeding

dieulafoy lesion

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what are the precursor lesions of intestinal gastric adenocarcinoma

gastric dysplasia and adenomas

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how does autoimmune gastritis cause neurological defects

autoimmune gastritis –> vitamin B12 deficiency –> degeneration of spinal cord, demyelination of spinal tracts –> paresthesia and numbness, memory loss

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API2-MLT fusion protein

MALToma

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location and size of stomach carcinoid tumors

body and fundus

- 1-2 cm

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linitus plastica (leather bottle) gastric wall

diffuse gastric adenocarcinoma

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sx of fundic gland polyps

none, nausea

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symptoms of stomach carcinoid tumors

gastritis

- ulcer

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local ischemia leading to upregulation of NO synthase and increased release of endothelin 1 (vasoconstrictor)

stress related gastric mucosal injury

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compare location b/w menetrier disease and zollinger-ellison syndrome

menetrier: body and fundus

zollinger-ellison: fundus

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sx of acute gastritis and gastropathy

may be asymptomatic or cause epigastric pain, nausea, vomiting
- more severe cases: mucosal erosion, ulceration, hemorrhage, hematemesis, melena, blood loss

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longitudinal stripes of edematous erythematous mucosa alternating with less severely injured, paler mucosa

“watermelon stomach”

gastric antral vascular ectasia (GAVE)

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solitary, well circumscribed fleshy masses, on cut surface shows whorled appearance

gastrointestinal stromal tumor (GIST)

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how does H. pylori cause gastric injury

urease-secreting H. pylori inhibits gastric bicarbonate transporters by ammonium ions

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sx of gastritis cystica

similar to chronic gastritis

nausea, upper abd pain, sometimes vomiting

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germline loss of function mutation of CHD1

diffuse gastric adenocarcinoma

diffuse foveolar cell hyperplasia of the body and fundus due to overexpression of TGF-a

menetrier dz

most frequent complication of peptic ulcer dz

bleeding

behavior of jejunum and ileum carcinoid tumors

aggressive

list the protective factors of the gastric mucosa

- surface mucus secretion - bicarbonate secretion - mucosal blood flow - epithelial barrier - epithelial regeneration capacity - prostaglandins

what patients are most likely to get stress ulcers

pts w/ shock, sepsis, or severe trauma

compare association w/ adenocarcinoma b/w menetrier disease and zollinger-ellison syndrome

menetrier: associated zollinger-ellison: not associated

disease associations with stomach carcinoid tumors

- atrophic gastritis | - MEN1

secretory products of stomach carcinoid tumors

- histamine - somatostatin - serotonin

sx of inflammatory and hyperplastic polyps

similar to chronic gastritis | nausea, upper abd pain, sometimes vomiting

where can acute stress ulcers be found

ANYWHERE in the stomach

ulcers in the proximal duodenum associated with severe burns or trauma

curling ulcers

"salt and pepper" appearance of a tumor indicates

neuroendocrine tumor (carcinoid tumor)

sx of chronic gastritis

n/v and upper abd pain

how do NSAIDs cause gastritis

NSAIDs inhibit COX --> cannot make prostaglandins E2 and I2 --> can no longer stimulate defense mechanisms (HCO3-, mucus, phospholipids)

sharply punched out defect with over hanging mucosal borders and smooth, clean ulcer bases

peptic ulcer disease

list the injury-causing (not normal) damaging factors to the gastric mucosa

- H. pylori - NSAIDs - tobacco - alcohol - gastric hyperacidity - duodenal-gastric reflux

tumor arising from diffusely distributed endocrine cells causing endocrine cell hyperplasia

carcinoid tumors (well differentiated neuroendocrine tumors)

sx of MALToma

dyspepsia and epigastric pain, possible hematemesis, melena, and weight loss

ulcers of PUD are most common where

- proximal duodenum - near pyloric valve - anterior duodenal wall

ongoing gastric mucosal inflammation with mucosal atrophy

chronic gastritis

compare symptoms b/w menetrier disease and zollinger-ellison syndrome

menetrier: hypoproteinemia, weight loss, diarrhea zollinger-ellison: peptic ulcers

demographic for autoimmune gastritis

median age 60 years, women > men

what cells secrete mucin

surface foveolar cells

hypergastrinemia and decreased pepsinogen due to destruction of chief cells

autoimmune gastritis

(+) neuroendocrine markers

carcinoid tumors (well differentiated neuroendocrine tumors)

compare associations of H. pylori gastritis and autoimmune gastritis

H. pylori: low socioeconomic status, poverty, rural areas autoimmune: autoimmune disorder, thyroiditis, DM, grace's

yellow-tan intramural or submucosal masses leading to small polypoid lesions

carcinoid tumors (well differentiated neuroendocrine tumors)

why are older adults more susceptible to gastritis

they have reduced mucin and bicarbonate secretion

most common malignancy of the stomach

gastric adenocarcinoma

mesenchymal tumor that arises from interstitial cells of Cajal

gastrointestinal stromal tumor (GIST)

risk factors for gastritis cystica

trauma or prior surgery

pathogenesis of autoimmune gastritis

CD4+ T cell destruction of parietal cells --> loss of HCL and IF production

APC, TGF-B, BAX, CDKN2A loss of function mutations

intestinal gastric adenocarcinoma

compare inflammatory infiltrate of H. pylori gastritis and autoimmune gastritis

H. pylori: neutrophils, subepithelial plasma cells autoimmune: lymphocytes, macrophages

where are MALTomas most often located

most commonly arise within tissues normally devoid of organized lymphoid tissue

presence of neutrophils above the basement membrane in the GI tract indicates ____

gastritis

ulcer base that is brown to black (due to blood)

stress related gastric mucosal injury

diffuse mucosal atrophy with prominent lymphoid aggregates

chronic H. pylori gastritis

compare location of H. pylori gastritis and autoimmune gastritis

H. pylori gastritis: antrum autoimmune: body

which gastric polyps are associated with adenocarcinoma?

- gastric adenomas - familial adenomatous polyposis - occasionally inflammatory and hyperplastic polyps

autoantibodies against parietal cells and H+/K+ ATPase and if

autoimmune gastritis

GI pain referring to the back, LUQ, and chest

peptic ulcer disease

compare inflammatory infiltrate b/w menetrier disease and zollinger-ellison syndrome

menetrier: lymphocytes zollinger-ellison: neutrophils

CXR showing free air under diaphragm

perforation into the peritoneal cavity due to ulcer from PUD

diagnostic testing for H. pylori gastritis

- urea breath test (for ammonia production) - biopsies - fecal bacteria detection - serologic test for antibodies

epigastric burning or aching pain that is worse at night and 1-3 hours after meals

peptic ulcer disease

giant cerebriform enlargement of rugal folds due to epithelial hyperplasia without inflammation

hypertrophic gastropathies

chronic mucosal ulceration of the lesser curve of the stomach at the antrum or proximal duodenum, associated w/ H. pylori and NSAIDs

peptic ulcer disease

where are most gastric adenocarcinomas found

antrum

where does H. pylori most often affect

antrum of stomach

compare mean patient age b/w menetrier disease and zollinger-ellison syndrome

menetrier: 30-60 zollinger-ellison: 50

extranodal lymphoma arising anywhere in the GI tract as a result of chronic inflammation

MALToma | mucosa-associated lymphoid tissue

erosion and hemorrhage in the setting of acute gastritis

acute erosive hemorrhagic gastritis

most common mesenchymal tumor of the abdomen

gastrointestinal stromal tumor (GIST)

what is the characteristic feature of acute gastritis

neutrophils

associations with endocrine cell hyperplasia, vitamin B12 deficiency, and defective gastric acid secretion

autoimmune gastritis

causes of gastropathy

- NSAIDs - ETOH - bile - stress-induced injury - portal HTN

describe the state of the gastric mucosa in an ulcer

- loss of mucus, mucosa, and muscularis mucosae | - layer of necrosis --> inflammation --> granulation tissue --> fibrotic scar (NIGS)

two types of hypertrophic gastropathies

- menetrier dz | - zollinger-ellison syndrome

increased Wnt signaling

intestinal gastric adenocarcinoma

list the "normal" damaging factors to the gastric mucosa

- gastric acidity | - peptic enzymes

gastrin secreting tumors of the stomach, small bowel, or pancreas

zollinger-ellison syndrome

how does erosion occur in acute gastritis

neutrophils invade the epithelium causing superficial epithelial sloughing

what is the "carney triad"

seen in young females - GIST - paraganglioma - pulmonary chondroma

associated w/ pernicious anemia

autoimmune gastritis

ulcers in the esophagus, stomach, and duodenum that are associated with increased intracranial pressure

cushing ulcer

histo: intraepithelial and luminal neutrophils forming pit abscesses

H. pylori gastritis

compare gastrin levels of H. pylori gastritis and autoimmune gastritis

H. pylori: normal to decreased autoimmune: increased

most common cause of chronic gastritis

H. pylori | second is autoimmune gastritis

histo: foveolar cell hyperplasia and corkscrew profiles and epithelial proliferation

gastropathy and acute gastritis

pathogenesis of cushing ulcer

increased intracranial pressure leads to direct stimulation of vagal nuclei leading to hypersecretion of gastric acid

sx of gastric adenomas

similar to chronic gastritis | nausea, upper abd pain, sometimes vomiting

imbalances between mucosal defense mechanisms and damaging factors that cause chronic gastritis

peptic ulcer disease

secretory products of jejunum and ileum carcinoid tumors

serotonin, substance P, polypeptide YY

compare acute gastritis and gastropathy

acute gastritis: neutrophils | gastropathy: rare or absent inflammatory cells

causes of gastric antral vascular ectasia (GAVE)

idiopathic or associated with cirrhosis or sclerosis

risk factors for gastric adenomas

chronic gastritis, atrophy, intestinal metaplasia

tx for MALToma

combination antibiotic therapy

what stain diagnoses chronic gastritic

warthin-starry stain

risk factors for peptic ulcer dz

- h. pylori - tobacco use - COPD - illicit drugs - NSAIDs - alcohol cirrhosis - stress

compare serology of H. pylori gastritis and autoimmune gastritis

H. pylori: antibodies to H. pylori autoimmune: antibodies to parietal cells and intrinsic factor

diagnostic lymphoepithelial lesions in antrum w/ spiral organisms

MALToma w/ H. pylori

non-tender mass in supraclavicular fossa indicates ____

gastric adenocarcinoma

CDH1 loss of function

gastric adenocarcinoma

signet ring cells on histo

gastric adenocarcinoma